LONDON -- ''We can't claim victory until the fat lady really sings,'' said Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, at the 11th international conference on AIDS in Vancouver. ''She hasn't sung yet, but I think she is getting ready to sing.''
This month's Vancouver conference marked the first time that researchers think they are getting close to effective treatments for AIDS and its precursor, HIV infection. New combinations of drugs, particularly the class known as protease-inhibitors, are producing startling cases of remission from full-blown AIDS, and have reduced the HIV virus in the blood of HIV-positive people to undetectable levels for up to half a year.
If these early results are borne out by further tests, and if the new drugs continue to suppress the HIV virus over a period of years without severe side effects, then this is wonderful news for millions of HIV-positive people.
More precisely, it is wonderful news for those HIV-positive people who live in countries that can afford the $15,000-$20,000 annual per-capita cost of the treatment, and in social environments that let them follow a regimen of treatment involving up to 20 pills a day and strict dietary rules. It means nothing to the other 90 percent of HIV-infected people, who live in the Third World.
Half of Uganda's adults
In Uganda, according to a 1991 report of the U.N. Food and Agriculture Organization, ''it is estimated that half the population over 15 years of age is HIV-positive.'' Uganda has no money to save these people even if a cure is found -- so half its adult population is destined to die in the next 10 years.
This is a level of casualties normally associated only with scenarios for nuclear holocaust. The U.S. Census Bureau estimated two years ago that life expectancy in Uganda, projected at 59 years before AIDS began decimating the population, will fall to only 32 years by 2010.
The rest of west, central and east Africa faces a catastrophe only slightly less dramatic: more than half the hospital beds in several big cities in the region are now occupied by AIDS patients. Even South Africa, where health care and nutrition are well above the continental average, now has an HIV infection rate of 7.6 percent.
Infection rates are also so high in some non-African countries that they have drastic implications for population size. The same 1994 U.S. Census Bureau report estimated that in Brazil, Haiti and Thailand, plus the 13 worst-affected African countries, the cumulative AIDS toll by 2010 will be so great as to leave them with 121 million fewer people than was previously forecast.
New protease-inhibiting drugs will save almost none of these lives -- nor those of the tens of millions of people in Asian countries like India and the Philippines where HIV infections are spreading just as fast, but are less well reported. The hope dawning in Vancouver is only hope for the relatively rich. But there is hope of a less expensive variety dawning elsewhere. Two recent public-health programs have shown tremendous success in reducing the rate of HIV infection.
Three years ago, the Tanzanian government and the London School of Hygiene and Tropical Medicine selected 12 villages along the shores of Lake Victoria where HIV was spreading through the population at the rate of 1 percent a year.
In half, they gave the village health centers extra training and low-cost drugs to deal with other sexually transmitted diseases (thought to be a factor in HIV infection), and an education program encouraged the villagers to seek treatment for venereal diseases. In the other six villages, they left things as they were.
At the end of two years, the difference was stark. New HIV infections in the six villages that got extra attention were 42 percent lower than in the others.
Thailand's AIDS problem is so severe that the U.S. Census Bureau predicted that the average life-span would fall from 75 to 45 years and the country's population would drop one percent by 2010. The man most responsible for turning this situation around is Mechai Viravaidya, the director of the Population and Community Development Association.
''Cabbages and Condoms''
Mr. Mechai's genius for publicity is epitomized by the ''Cabbages and Condoms'' restaurant he runs in Bangkok. He first made his name with a brilliantly successful birth-control program in the 1970s and '80s; with government support but no compulsion, he helped to reduce the size of the average Thai family from seven children to only two in just 20 years.
In 1991, when the Thais realized the size of their AIDS problem, Mr. Mechai was the obvious man to turn to. ''We made a projection that if nothing were done from 1991 to the year 2000, we would have between 2 million and 4 million HIV-positive cases,'' he told me last year.